Clinically important points
* Endocrine causes of obesity:
- Hypothyroidism ( Wt. Gain rather than obesity
- Hypogonadism.
- Hypopitutarism & hypothalamic : Froehlich syndrome.
- Cushing syndrome : ( Fat redistribution ).
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* Hazards of obesity :
- General : Shorter life expectation .
- C.V.S.: Atherosclerosis, HTN, IHD, DVT, V.V.& Thromboembolism.
- Respiratory: Post op. Chest complications & Pickwickian S. .
- Metabolic : DM & fatty liver.
- Skeletal system: O.A., lumbar disc prolapse, & skeletal deformities.
- G.I.T.: Constipation, gallbladder dis.,& hiatus hernia.
- Neurological : C.T.S. & hypersomnia.
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* Causes of emaciation :
- General debilitating diseases.
- Chronic infection.
- Malignancies.
- G.I.T. : Dysphagia, repeated vomiting, malabsorption & ch. diarrhea.
- Endocrine : thyrotoxicosis, D.M., Addison disease .
- Psychological : anxiety, anorexia nervosa & depression.
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* Pallor : ( causes ):
- Anemia - Acute hemorrhage. – Shock & decr. C.O.P. . - Panhypopitutarism.
- Acute nephritis. –Facial edema. -
-HTN - Infective endocarditis.
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* Cyanosis :
i) Central cyanosis :
a) Cong. Cyanotic heart disease : F4 & Eisenmenger s.
b) Lung diseases : COPD, Interstitial fibrosis, collapse, pulm. Edema, tension Pneumothorax, pulmonary embolism.
c) Abnormal Hb.: Met Hb., & Sulph Hb.
ii) Peripheral cyanosis :
a) Polycythemia .
b) Peripheral vascular disease : Raynaud, venous thrombosis, & arterial occlusion.
c) Cold.
d) CHF
e) Decreased C.O.P.
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* D.D. of yellow coloration of skin & sclera:
a) Picric acid toxicity. b ) atebrin
c) Xanthomatosis c) Carotenemia
d) Myxedema d) Uremia.
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* Causes of hyperpyrexia (temp. >40.5 ):
a) Heat stroke b) Encephalitis
c) Pontine hemorrhage d) Status epilepticus.
e) Thyrotoxic crisis f) Hypothalamic trauma
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* Causes of hypothermia : ( temp. < 35 ):
a) Shock b) Hypothyroid coma
c) Panhypopitutarism d) Starvation
e) Chronic debilitating d. f ) Anterior hypothalamus damage
g) Drugs : eg : Phenothiazine
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* Cause of secondary HTN: ( curable HTN ):
a) Renal : vascular or parenchymatous
b) Endocrine : Acromegally, cushing, conn’s, pheochromocytoma & myxedema.
c) C.V.S.: Coarctation of aorta & polyarteritis nodosa.
d) C.N.S.: Hypothalamic lesion & bulbar poliomyelitis.
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* Causes of hypotension:
a) Decreased C.O.P. eg : H.F. & infarction.
b) Decreased peripheral resistance: shock , vaso-vagal attacks.
c) Inadequate blood volume : massive hemorrhage & severe dehydration.
d) Miscellaneous: Addison dis., D.M., debilitating illnesses, excess hypotensive drugs.
* Uses of sphygmomanometer :
a) B.P. measurement. b ) Closed vensection
c) Hill’s sign of A.R. d ) Hemostasis.
e) Detection of latent tetany. F ) Coarctation of aorta diagnosis.
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* Irregular pulse :
a) Irregular irregularity :
i) A.F.
ii) Multiple extrasystole
iii) Heart block of changeable degree
iv) Ventricular fibrillation.
v) Atrial flutter with changeable degree of a-v block.
b) Regular irregularity :
i) Pulsus bigeminy or trigeminy.
ii) Dropped beat at regular rate.
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* Water hammer sign :
a) A.I. b ) P.D.A. c) A-V fistula
d) Pregnancy e ) Fever f) Anemia
g) Thyrotoxicosis
N.B. Causes of big pulse pressure : as water hammer sign causes + a) Heart block b) Atherosclerosis
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* Variable pulse volume :
a) Pulsus alternans b) Complete heart block.
c) Ventricular tachycardia d) A.F.
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* Unequal pulse ( causes ):
a) Aortic aneurysm. b ) Pan coast tumor
c) Embolism or thrombosis of brachial & subclavian artery.
d) Atheromatous plaque at origin of subclavian artery.
e) Dissecting aortic aneurysm.
f) Coarctation of aorta.
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* Loss of outer 1/3 rd of eye brow :
a) Myxoedema b) Leprosy
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* Puffiness of eye lid :
a) Fatigue b) Ch. Cough c) Excessive crying
d) Nephritis e) Nephrotic s. f) Myxoedema
g) Thyrotoxicosis h) Pericardial effusion i) Mediastinal syndrome.
j) Beri Beri k) S.V.C. obstruction.
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* Exophthalmos :
a) Thyrotoxicosis
b) Cavernous sinus thrombosis
c) A-V aneurysm between ICA & cavernous sinus(pulsating exophth.)
d) Congenital exophthalmos .
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* Enophthalmos :
a) Dehydration b) Shock
c) Severe wasting
d) Horner syndrome ( Ptosis, miosis, anhydrosis & enophthalmos ).
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* Sub-conjunctival hemorrhage :
a) Severe cough & straining b) Infective endocarditis
c) Malignant HTN. d) Hemorrhagic blood diseases
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* Blue coloration of scelra :
a) T.B. b) Ankylostoma anemia
c) Osteogenesis imperfecta d) Children
e) May be in normal persons.
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* Breath odour :
a) Halitosis : - local oral conditions : dental , ulcer, tonsillitis
- Suppurative lung diseases
- Pyloric obstruction
- Gastro colic fistula
b) Alcohol : in chronic alcoholics
c) Acetone : DKA
d) Amonia : uremia
e) Foetor hepaticus : L.C.F.
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* Bleeding gum :
a) Infection b) Leukemia
c) Vit. C deficiency. d) Purpura
e) Local dental causes.
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* Parotid enlargement :
a) Mumps b) Nephrotic syndrome
c) Liver cell failure d) Ankylostoma
e) Mickulicz s. f) Sjogren’s syndrome.
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* Sprasternal notch pulsation :
a) Coarctation of aorta & A.I.
b) Aortic arch aneurysm.
c) Hyper dynamic circulation.
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* Exaggerated carotid pulsation :
a) A.I. ( Corrigan’s sign ). b ) HTN
c) Coarctation of aorta d) Thin neurotic individuals
e) Aneurysm of carotid artery f) Thyrotoxic goiter
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* Comparison between venous & arterial pulsations:
|
Venous pulsation |
Arterial pulsation |
|
Wavy |
One wave - Jerky |
|
Have an upper level |
No upper level |
|
Change with position |
Not affected by position |
|
Better seen than felt |
Better felt than seen |
|
Disappear on jugular compression |
Not affected |
|
Hepato-jugular reflex usually present |
Absent |
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* Prominent A wave :
a) T.S. b) P.S. c) I.H.S.S. d ) Pulmonary HTN.
e) Rstrictive cardiomyopathy f) Massive pulmonary embolism
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* Increased venous pressure :
a) Engorged non-pulsating neck veins :
- SVC obstruction - Mediastinal syndrome
b) Engorged slightly pulsating neck veins :
- COPD - Big pleural effusion.
- Tension Pneumothorax - Cardiac Tamponade
c) Engorged pulsating neck veins :
- Rt. Ventricular Failure - T.I & T.S.
- Increased intra-abdominal pressure
- Anemia & thyrotoxicosis
d) Engorged neck vein with inspiratory filling :
- Pericardial effusion - Constrictive pericarditis
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* palpable thrill in the neck :
- A.S. – Thyrotoxicosis - Carotid artery aneurysm
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* Hand temperature:
|
Warm hand in: |
Cold hand in: |
|
Thyrotoxicosis |
Neurotic individual |
|
Chronic alcoholism |
Low C.O.P. |
|
Liver cell failure |
Raynaud’s phenomena & disease |
|
A-V fistula |
Peripheral cyanosis |
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